JSS: November 2008 Archives

Are you doing what you can to protect your child from sexual abuse? The standard advice is wrong: Here's what you need to know.

 copyright Jessica Snyder Sachs, as first published in PARENTING magazine

When I was 11, I kept a terrible secret from my parents. I feared their reaction if they found out what a neighbor and family friend had done in his home after turning off the lights and saying he loved me. Besides, it took me months to figure it out myself. Even then, I doubt that the term "molestation" had become part of my vocabulary.

My story wouldn't bear mentioning except that it continues to be horribly common. Although studies show a small but steady decline in substantiated child molestations over the past decade, conservative estimates still place the number of children who are sexually abused each year at around 200,000. Only about half of cases are reported, experts believe. And the problem extends into younger age groups than most people realize. In a national survey of adults molested as children, the median age of first abuse was 9 years, with one-fourth being violated before age 8 and nearly 15 percent before age 6.

Scarier still, conventional notions on how to protect kids is wrong. We rush to teach them about "stranger danger," but more than 80 percent of molesters know their victims, according to a study by the University of New Hampshire's Crimes Against Children Research Center. We instruct our children to "Yell and Tell," but such simplistic advice can backfire when youngsters face the typical offender  -- the outwardly caring teacher, coach, friend, or relative who's worked hard to win your child's trust  -- not to mention yours.

"In no other area do we give children the responsibility to stop or change the behavior of the adults in their life," says Elizabeth Ralston, Ph.D., executive director of Dee Norton Lowcountry Children's Advocacy Center, in Charleston, South Carolina. "The result is that often, kids who've been molested feel guilty for not having prevented the abuse and ashamed to tell anyone about what's happened to them."

Even lessons on "good touch/bad touch" can backfire because molestation doesn't always start out feeling "yucky." Nor does it necessarily involve physical contact, as is the case when adults expose children to sexually explicit pictures, talk, and behavior, or when they get them to expose themselves for photographs.

You're probably cringing right about now, but that discomfort is a part of the problem. "It's natural for parents to cling to the myth of the child molester as the dirty old man in the wrinkled raincoat," says Anna Salter, Ph.D., author of Predators: Pedophiles, Rapists, and Other Sex Offenders. "It's disturbing to think that people we know, or even love, could harm our children."

Your first line of defense, then, is to minimize the situations in which your child is left alone with an adult you don't thoroughly know and wholly trust  -- even if it's Grandpa. "This isn't about being paranoid," says Anne Lee, founder of the national child-protection campaign Darkness to Light and a survivor of sexual abuse herself. "Just as we're not being paranoid about the risk of an accident, so we buckle our kids into their car seats or hold their hands crossing the street, it's not paranoid to eliminate one-on-one situations that may put them at risk of abuse." These age-specific guidelines can help you keep your child safe.

Protecting Infants and Toddlers

It was the grandma who noticed. While diapering her 14-month-old granddaughter, she felt a roughened area between the baby's buttocks. The pediatrician said it was too calloused to be diaper rash and concluded it had been caused by chronic rubbing over a long period of time. It turned out, says Ralston, that the teenage boy who babysat the child had been masturbating against her.

Yes, babies get abused. A molester may masturbate against an infant or toddler, stimulate the child for self-gratification, or even attempt penetration. Red flags for possible abuse include abrasions, swelling, and skin tears around the genitals, anus, or mouth. If you notice such an injury, see your doctor immediately.

Ralston urges parents to screen any adult they're considering as a regular caregiver for criminal offenses through local law-enforcement agencies and the FBI. You'll need the person's birth date, social security number, and a list of the counties and states in which she's lived.

After you hire someone, make it clear to her that you're vigilant about your child's safety and then check in unannounced periodically. "If she complains, find somebody else," says Ralston.

Protecting preschoolers and grade-schoolers

"See. You're a dirty little girl. You like it." That's what Anne Lee's great-uncle told her when he began fondling her during summers at the family's vacation house. She was 4 years old.

"The tragedy is, I believed him and felt too ashamed to tell my parents," says Lee, who's now the mom of a 10-year-old daughter. At the same time, Lee's behavior was a cry for help: "Here we had this wonderful place on a beautiful crystal lake, and I was begging not to go."

Although there are no numbers available regarding boys, the incidence of molestation and sexually motivated abductions of girls more than triples by the time children reach grade school. This isn't surprising, considering that as kids get older, they're out of their parents' sight more often. To protect them despite this change:

Reduce accessibility
There's no substitute for direct supervision. "Offenders look for ease of approach and ease of retreat," says Monique Boudreaux, Ph.D., a consultant with the Child Abduction and Serial Murder Investigative Resources Center, in Quantico, Virginia, and a mom of two. So plop down on a lawn chair when your kids play outside; take the phone along or let the voicemail pick up to avoid having your attention diverted.

Before your child visits a friend's home, get to know the parents or try to spend time there. If you're not comfortable, have them play at your house.

At your child's daycare or school, find out if there's an "open-door policy"  -- that is, an open door or unobstructed window should allow any classroom to be visible from the hallway at all times.

If you've chosen family daycare for your child, make it clear that she should never be left with anyone other than the primary caregiver without your prior approval. When babysitters come into your home, establish ground rules as to who else is allowed in the house while you're away.

Attend your child's practices, lessons, and other extracurricular activities, or send someone you trust. Relax on the sidelines, but be aware of how coaches and instructors interact with your child.

Never ignore the protests of a child who expresses reluctance or fear about spending time with a particular adult, even a relative or close family friend. Avoid leading questions, but assure your child that he won't get in trouble for telling you what's going on.

Reduce desirability
Advertising your child's name on the outside of backpacks and other personal items can draw unwanted attention. "We know that some offenders literally stalk children to gain information about them," says Boudreaux. "Knowing your child's name helps them." At the very least, it can make it easier for a molester to directly gain a child's trust.

In a more literal sense, reducing desirability means not dressing young children in alluring clothing, accessories, or makeup. Interviews with convicted child molesters suggest that a provocative appearance plays a significant role in the selection of victims.

Reduce vulnerability
Although it's important not to lay the responsibility of protecting themselves solely on the tiny shoulders of preschoolers, they are old enough to learn that their bodies are their own and that the parts normally covered by underwear or a swimsuit shouldn't be touched or seen by others, with the exception of a parent or trusted caregiver at bathtime or a doctor examining them with a parent or nurse present. They should understand that others should not be exposing or showing pictures of private parts to them. This sense of "owning one's body" begins with the child's privilege of saying no when he doesn't feel like hugging or kissing, even if that person happens to be Granddad  -- or you.

Similarly, don't tell your child to be a good boy (or girl) and do whatever his sitter (teacher/coach/neighbor) says. Boudreaux teaches her own kids reasonable and acceptable behavior while letting them know they have the right to politely but firmly say no if they're told to do something that doesn't seem right. It can help to playact nonscary scenarios in which your child should "talk back" to an adult.

Instead of teaching fear of strangers, Boudreaux also instructs her children to look for "a mommy with kids or a grandma" if they get separated from her in a store or elsewhere. (Recognizing a store clerk or security guard can be difficult for little ones.)

Reducing vulnerability means making sure your child feels safe coming to you about a disturbing or confusing situation or emotion. Tell her, in terms she can understand, that some adults  -- not very many, but some  -- try to touch or otherwise interact with children in inappropriate ways.

Protecting tweens and up

My daughter's now 11, the age at which I was molested  -- and I've gone through many a heart-clenching moment when she's been out of my sight. To protect maturing kids without smothering them:

Continue to get to know your preteen's friends, and if possible visit their homes.

Encourage supervised activities with kids her own age, explaining that while relationships with adults and older teens may be fun and exciting, she may find herself in a vulnerable position that can lead to abuse. Pay special attention to friendships involving older persons, even a 14-year-old palling around with your 10-year-old.

Kids approaching and passing through puberty also need help managing their own sexual feelings, setting boundaries with boy- and girlfriends, and handling peer pressure regarding pornography. Look for opportunities to talk about these issues and brainstorm ways for your child to avoid or get out of uncomfortable situations.

Finding a balance

Protecting kids from molestation requires being vigilant while giving them freedom to learn about their world, make friends, and become independent adults. For me, that's meant choosing a preschool with two teachers in every class; sitting in on music lessons; and having quite a few frank talks with my daughter about sexuality and molestation. Not as much fun as chatting about her interest in Shakespeare or horses, but vital to making sure she never has to experience the kind of shame and confusion that I did as a child.

Parenting contributing editor Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health & Survival in a Bacterial World (Hill&Wang/FSG) and Corpse: Nature, Forensics, and the Struggle to Pinpoint Time of Death (Perseus/Basic Books).

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Hospitals need to come clean about infections and what's causing them.

copyright Jessica Snyder Sachs, as originally appeared in The [Newark] Star-Ledger

Our neighborhoods are in a panic over news reports about MRSA, or methicillin resistant Staphylococcus aureus. There's no doubt that this nasty bug has moved into our communities and our schools. But the deadliest threat from MRSA--and an alphabet soup of other drug-resistant bacteria--remain behind the doors of our local hospitals. Eight-five percent of MRSA infections occur during or following a stay in a healthcare facility.

Illustration by Paul Lachine

The sad truth is that our hospitals have become dangerous places to be sick. Even routine surgical procedures bring the risk of potentially deadly infections involving hospital-bred bacteria. Infections picked up in health-care settings kill an estimated 99,000 Americans each year, more than twice as many as die in car crashes. It's a problem that has grown dramatically worse by the decade, as our antibiotic-infused medical centers became breeding grounds for drug-resistant bacteria.

In addition to MRSA,  other increasingly common hospital superbugs include a viciously toxic strain of Clostridium difficile, bred from the bacterium that commonly causes post-antibiotic diarrhea; vancomycin resistant enterococcus (VRE), a virtually untreatable bug bred from a harmless member of our intestinal microflora; and Actinobacter baumannii, another near-unstoppable microbe, this one recently introduced into our hospitals in the infected wounds of soldiers returning from Iraq, Afghanistan, and before that, Kuwait.

The good news is that a half century of dangerous secrecy is starting to come to an end. This year New Jersey joined New York and Connecticut in the ranks of at least 22 states with some sort of mandate for the reporting of hospitals infections. These laws represent a step in the right direction. But few ask hospitals to differentiate infections caused by "ordinary" bacteria and those caused by highly drug resistant superbugs. New Jersey is one of these exceptions, with a new law on the books requiring specific reporting of hospital MRSA.

The importance of such reporting laws goes beyond a consumer's desire to steer clear of a medical center plagued with abysmal infection control. Worse, fifty years of secrecy have left public health officials guessing as to the arrival and spread of deadly new strains of drug-resistant bacteria in our hospitals.

The current situation with C. difficile illustrates the problem. Since 2003, C. difficile deaths have dominated news in Canada and the United Kingdom. British tabloid headlines like "Toe Nail Surgery Nearly Killed Me" refer to the common scenario wherein someone checks into the hospital for a routine procedure, receives antibiotics, and promptly contracts this drug-resistant invader.

Public outcry in Canada and the UK produced tremendous political pressure to address the problem in those countries. Even today, British lawmakers are quick to call the government's health minister before Parliament for public castigation when quarterly hospital reports of either MRSA or C. difficile rates fail to show improvement.

Ironically, in 2005, medical detectives traced the origins of the toxic C. difficile strain wreaking havoc in Canada and the U.K. to the United States, where hospitals had been heedlessly experiencing deadly outbreaks for at least six years. "We had no idea what was going on," admitted the chief of infection control at the University of Pittsburgh Medical Center, which in 2005 belatedly reported that its own C. difficile death toll had begun a dramatic ascent in January 2000.

Once forced to examine and deal with their superbug problems, hospitals can make great strides. This month, a once-chastened University of Pittsburgh Medical Center reported that it has brought its C. difficile rates down by more than 70 percent with an aggressive combination of tactics that include requiring doctors to get permission from an antimicrobial management team before prescribing the kind of powerful antibiotics known to raze the body's good bacteria and, so, leave a patient vulnerable to C. difficile and other drug-resistant bacteria.

Once their dirty secrets are out, other medical centers can likewise begin sharing and comparing infection control efforts. To that end, the first round state laws requiring hospitals to report infections in a general way do not go far enough. Our state legislators need to ride the current wave of public concern about supergerms to pass further legislation requiring hospitals to report on infection problems on a bug by bug basis--starting with their most dangerous and drug-resistant bacteria.

Jessica Snyder Sachs, a contributing editor to Popular Science and Parenting magazines, is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World.

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Many of us are in the danger zone, and we don't realize it. What to do right now.

by Jessica Snyder Sachs, as first appeared in HEALTH magazine

How's your cholesterol? Here's a guess: If you're healthy, you probably have no idea. New surveys show women tend to be clueless about their risks of heart disease, especially when it comes to managing their cholesterol.

But this kind of ignorance is anything but bliss. The reason: The artery clogging that makes heart disease the number-one killer of women late in life begins much earlier--in your 20s, 30s, and 40s--and that's when your cholesterol numbers may be sounding alarms. So, are you ready to start paying attention? Here, the things all women need to know now.

1. High cholesterol is surprisingly common in premenopausal women.
Researchers with the Framingham Heart Study recently delivered a nasty surprise: Nearly a quarter of women in the study who are in their early 30s have borderline-high levels of bad cholesterol, as do more than a third in their early 40s and more than half in their early 50s. A third of women in all three age groups have low levels of good cholesterol.

Bad cholesterol, also known as low-density lipoprotein (LDL), contributes to heart disease by laying down artery-clogging plaque; good cholesterol, or high-density lipoprotein (HDL), helps clear it away. "The double whammy of high LDL and low HDL is particularly dangerous," says Framingham researcher Vasan Ramachandran, MD, of the Boston University School of Medicine.

2. Your doctor may miss the problem.
Though women are better than men about seeing a doctor regularly, the care they receive isn't as good when it comes to preventing and treating cardiovascular disease, according to new studies. "Perhaps doctors still haven't gotten the message that women need to control cholesterol," says Chloe Bird, PhD, author of one of these studies and a senior sociologist at the nonprofit RAND Corporation. Bird found that doctors are less likely to monitor and control cholesterol in women than in men, even when the women are at superhigh risk of heart attack.

Part of the problem, she says, may be that many women see only a gynecologist. This isn't to say that OB-GYNs can't be good primary care doctors, but you have to make sure the doc is willing to monitor your heart health, especially if you already have diabetes or a heart issue. That means she should order cholesterol checks as part of your regular blood work and discuss the results with you. What does "regular" mean? See "How Often Do I Need a Checkup?"

3. Your numbers may trick you.
Many people misunderstand the roles of so-called good and bad cholesterols, according to cardiologist and lipidologist Pamela Morris, MD, of the Medical University of South Carolina in Charleston. "What we've learned is that HDL and LDL are independent predictors of a woman's heart attack risk," she explains. "We see women with high HDLs having heart attacks when their LDL is also high, and we also see heart attacks in women with very low LDL but also low HDL."

What that means to you: It's important to keep track of both. A woman wants to keep her HDL above 60 (the level at which HDL helps prevent disease) and her LDL below 100. If your HDL drops below 50 or LDL rises above 160, you need to take immediate action. That may include an LDL-lowering drug such as a statin, and it definitely includes a commitment to a heart-healthy diet and lifestyle.

4. You may need an "inflammation" test.
The math used to estimate your heart disease risk is a little misleading. If your LDL rises above the danger line of 160 or your HDL drops below 50, the math says you have an elevated risk of a heart attack within 10 years. But that warning may actually underestimate your risks beyond 10 years, Morris says. So when she has a female patient with cholesterol numbers in the intermediate range--LDL above 130 or HDL under 60--she often takes a close look at the woman's whole-body inflammation level.

You can't see this kind of inflammation, but it's actually an independent measure of heart attack risk. You measure it by adding a test for high-sensitivity C-reactive protein (hs-CRP) to the usual cholesterol blood work. CRP, essentially a body chemical, usually rises anytime your body becomes inflamed. And since artery clogging is associated with inflammation, high CRP is viewed as a marker for clogged arteries. That means your C-reactive protein levels may help you and your doctor decide how aggressively you need to control borderline-high-cholesterol levels with drugs, diet, and exercise.

5. These foods are your best friends.
Certain classes of food chemicals can actively and powerfully lower a person's bad cholesterol. Two--soluble fiber and phytosterols--have so much science behind them that they've become part of standard medical prescriptions for treating high cholesterol. But dietitian Janet Brill, PhD, RD, author of Cholesterol Down, also recommends regularly eating almonds, ground flaxseed, apples, soy protein, and olive oil. Preliminary research suggests they all have cholesterol-lowering powers. "Each one works in a slightly different way," Brill says. "So together, you get a synergy that can dramatically lower cholesterol."

Almonds and olive oil are high in monounsaturated fats, which are thought to blend with LDL molecules in a way that speeds LDL's clearance from the blood by the liver. Flax is high in both soluble fiber, which lowers LDL by absorbing cholesterol from both food and bile inside the intestines, and omega-3 fatty acids, which studies show have anti-inflammatory effects. Other foods especially high in soluble fiber include oat bran, oatmeal, and apples. (Soluble fiber is different from insoluble fiber, the kind found in whole-grain bread and bran cereal. That's good for you, too, but it won't affect your cholesterol.) Soy may mimic natural estrogens in their LDL-clearing effects. Phytosterols are the plant version of animal sterols (a.k.a. cholesterol) and lower LDL by competing with it for absorption into the body. They're found in supplements or phytosterol-enhanced margarine such as Benecol.

You don't need any of these foods if your LDL is low, but experts still recommend them for everyone. What about steak, eggs, and cheese? They sure won't help your cholesterol, because they all contain a lot of it. But it's more important to focus on foods that lower your numbers rather than simply avoiding the bad stuff, experts say.

6. Good cholesterol may have a bad side.
The higher your HDL, the better, right? That's been the current thinking, due to HDL's protective effect. But here's a surprise you may have read about in some news reports: Studies are showing that HDL may actually have harmful proteins capable of boosting heart disease risks. A test to determine if your HDL has the harmful proteins may be available in a few years. In the meantime, if your HDL is lower than 60, it's still OK to raise it a little as long as you don't go overboard. How? Try getting a lot of omega-3s from fish or fish oil, exercising regularly, controlling your weight, and avoiding smoking.

7. Your heart loves long walks.
Walking 10 miles a week brings lasting improvements in your heart health, according to researchers at Duke University Medical Center. The funny thing is, if you jog those 10 miles, you won't get quite as much benefit. "Duration appears to be key," says Duke's Cris Slentz, PhD, an exercise physiologist. "Jogging or walking 10 miles both burned around 1,200 calories, but in our studies, one took about two hours and the other, three."

Longer stints of exercise, even moderate exercise, may burn more belly fat--the little rolls of skin near your navel and the fat deep inside your abdomen. The latter is linked to metabolic syndrome, a condition associated with a host of cardiovascular risk factors including low HDL, high blood pressure, and high triglycerides (a kind of blood fat that contributes to heart disease).

Should you aim for weight loss as well as long walks? If you're overweight, absolutely. But understand that shedding a few pounds will make only a small dent in your cholesterol. Canadian researchers recently found that overweight women who lost about 25 pounds--no easy task--saw their LDL drop about 10 percent and their HDL rise by the same amount.

How Often Do I Need a Checkup?
Starting at age 19 and continuing until menopause, a cholesterol test once every five years is plenty--as long as your numbers fall in the healthy range:

HDL > 60
LDL < 100
Total cholesterol (HDL plus LDL) < 200.

But any time your numbers stray into unhealthy territory (and during and after menopause, when heart disease risk rises), get tested annually and work out an action plan with your doctor.

Writer Jessica Snyder Sachs is the author of Good Germs, Bad Germs, out in paperback this fall.

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MRSA infects 94,000 Americans a year, and the superbug is no longer confined to hospitals. Here's what you need to know to protect yourself and your kids.

copyright Jessica Snyder Sachs, as first appeared in BEST LIFE magazine

It started one morning last June, when 14-year-old Max Yardley felt a little tenderness in his elbow. The arm looked fine, so Max's dad, Rockie, an explosives specialist with the Edmond, Oklahoma, police department, figured the problem was soreness left over from the lifeguard training Max had just completed. But that night, Max woke up his parents at 3 a.m. The pain had become excruciating.

"This is a kid who doesn't normally complain," says Yardley. "He'd been sick all of five days in his life." The Yardleys raced to the emergency room. Over the next 24 hours, Max's temperature soared to triple digits and his blood pressure plummeted. When doctors ran the usual laboratory tests, it came back positive for methicillin-resistant Staphylococcus aureus, or MRSA. A bacterial infection had infected the bone of Max's upper arm and was racing through his body, shredding up his lungs, liver, and spleen.

"One morning we had a perfectly healthy boy. Twenty-four hours later, the doctors were struggling to keep him alive long enough for the antibiotics to start working," recalls Yardley, who, as a former paramedic, understood enough about his son's vital signs to call the family's priest.

Unknown just 15 years ago, community MRSA (hospital MRSA's virulent sister) now accounts for more than half the serious staph infections showing up in the nation's emergency rooms. Some children's hospitals see it in more than 75 percent of the staph-infected children they treat.

"Once it arrives in a community, it just seems to take over," says Sheldon Kaplan, MD, chief of infectious diseases at Texas Children's Hospital, in Houston. Pediatric specialists fear that the superbug, which already accounts for 19,000 deaths in the United States each year, could soon become commonplace across the country. The vast majority of community MRSA cases are skin and soft-tissue infections, Dr. Kaplan explains.

But around 5 percent involve potentially deadly pneumonias and internal infections such as Max's. When this bug enters the bloodstream, it can cause severe and sometimes fatal disease, and many of those who survive bloodstream infections sustain severe organ damage, require limb amputation, or both. "A child's growing bones remain particularly vulnerable," says Dr. Kaplan, "because they are open to bacteria circulating in the bloodstream."

Max was one of the lucky ones. After a week on a respirator, he emerged without permanent organ damage. After another two weeks on intravenous antibiotics, he finally went home to complete his recovery and was symptom free after another seven weeks on antibiotics.

Each year, more and more kids aren't so fortunate. MRSA deaths among previously healthy kids began cropping up in the 1990s. "At first we assumed these children had some connection to a health-care setting in which MRSA infections had been confined," explains epidemiologist Jeffrey Hageman, a MRSA expert with the Centers for Disease Control and Prevention, "but it eventually became clear that something else was going on." Antibiotic use outside of hospitals may have bred strains of MRSA distinct from those in medical centers.

And although community MRSA isn't resistant to as many kinds of antibiotics as is hospital MRSA, what it lacks in multidrug resistance it appears to make up for in virulence. Medical experts are just working out how staph in general, and MRSA in particular, wreaks its damage. But new studies suggest that community MRSA strains have the ability to kill the kinds of immune cells that would normally eliminate such microbial invaders. This stubborn persistence, in turn, tends to trigger septic shock, a kind of immune-system meltdown in which body-wide inflammation leads to organ failure, massive blood clotting, and plummeting blood pressure.

Community MRSA has an aggressive tendency to enter through even the smallest of cuts and abrasions. For this reason, it often spreads in locker rooms and gyms, and between members of sports and dance teams, who have frequent skin contact with both other participants' skin and shared surfaces such as athletic equipment and benches, explains Hageman.

Ineed, if you have a child in school or day care, chances are you've received some version of the panic-but-don't-panic note, as in "Dear parents: A confirmed case of MRSA infection has been brought to our attention. Please be assured we are taking appropriate measures." Some schools go so far as to shut their doors for a massive, one-time disinfection--a move that may be as ineffectual as it is overdramatic.

A less overblown but diligent effort is key, say health experts. "Perhaps one of the biggest problems for parents, dads in particular, is deciding when to give your kid Tylenol and send him to bed and when to go straight to the emergency room," says Yardley. "For me, it was the urgency of Max's complaints that raised the red flag."

Here's what you need to know to protect your children from community MRSA:

1. Know When Risk is Greatest
Studies show some of the highest rates of MRSA in groups such as team athletes and those who have had a medical procedure or taken antibiotics within the past year. MRSA is what doctors call an "opportunistic pathogen," a microbe that takes advantage of breaches in the body's defenses. Young children are particularly susceptible because their immune systems aren't yet fully developed. "Staph. aureus can't be eradicated," explains MRSA expert Jeffrey Hageman, of the Centers for Disease Control and Prevention. "Overall, around one in a hundred Americans carries a resistant strain of this bug."

2. Avoid Unnecessary Antibiotics
MRSA infection rates are up to eight times higher among those who've taken antibiotics in the previous year. By eliminating the drug-susceptible competition, antibiotics promote the success of any microbe that can shrug off their effects. "Antibiotics tend to replace your body's protective bacteria with drug-resistant troublemakers," explains Tufts University's Stuart Levy, MD, author of The Antibiotic Paradox. When antibiotics are necessary, ask your doctor for the "narrowest spectrum" (most specifically targeted) antibiotics, which tend to be less disruptive of the body's good bacteria than are "broad spectrum" (big gun) antibiotics.

3. Wash Away the Bugs
"Teaching children good hygiene is the single most important thing you can do to protect them," says Hageman. Staph spreads primarily through skin-to-skin contact and frequently touched surfaces. Experts recommend frequent hand-washing with ordinary soap and water or, when that's not convenient, an alcohol-based hand gel. "Staph takes several hours to infect an abrasion," says Hageman, "so there's a window of time when it can be washed from the skin."

Drug-resistance experts such as Levy advise against using antibacterial soaps containing chemicals such as triclocarban and triclosan. They act like antibiotics and, in laboratory tests, promote the rise of drug-resistant bacteria.

4. Keep Exercise Areas Clean Encourage young athletes--or their coaches--to wipe down mats and sporting equipment with soap and water or bleach wipes between uses. Children can also use a personal towel or other barrier between their skin and shared exercise surfaces and equipment. Insist on daily disinfection of locker rooms and weight-room benches, wrestling mats, and other shared athletic equipment as well as the mats used by younger children for napping. The Environmental Protection Agency maintains a list of safe and effective MRSA disinfectants.

5. When in Doubt, Check It Out
MRSA infections don't always look scary. The skin may become red, swollen, and tender. An infected joint, bone, or muscle may look normal but feel painful. Sometimes symptoms include fever, nausea, or weakness, says Sheldon Kaplan, MD, of Texas Children's Hospital. That can make MRSA infection difficult to distinguish from muscle sprains or the flu.

6. Get a Flu Shot
When MRSA and the flu end up in the same body, the result can be life-threatening. "It's the perfect storm," says John Francis, MD, an infectious disease consultant at Yale University School of Medicine. Getting an annual flu shot may help protect against this deadly combination.

Jessica Snyder Sachs is the author of Good Germs, Bad Germs, out in paperback this fall.

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Antibiotic-resistant germs are showing up in hospitals, playrooms, and gyms around the country. Here's how to keep you and your family safe

By Jessica Snyder Sachs, as first appeared in PREVENTION magazine

One summer morning in 2004, Susanne Petrosky, 37, of Perkasie, PA, woke up feeling feverish. It was a month after she'd given birth to her third child, and one touch of her left breast--hot, swollen, tender--told her it was infected. She knew the drill, having been through it with her second baby. She called her doctor, picked up a prescription for the antibiotic clindamycin, and took it faithfully for the full 7 days. No more breast infection. 

Then the diarrhea started, with cramping so bad it made her recent labor pains seem mild. She made an appointment to see her doctor and got on the Internet. "I typed in clindamycin and side effects and it came right up--severe, sometimes fatal, diarrhea," she says. On the phone, her doctor was reassuring. That was on a Thursday. She spent much of the weekend lying on the bathroom floor; on Monday morning her sister drove her to the doctor. "He took one look at me," Petrosky says, "and told us to go straight to the emergency room."

Petrosky had picked up a dangerous new strain of an old bug: Clostridium difficile. The bacteria, which produces toxins in the intestine, is common--when people on antibiotics end up with diarrhea, C. difficile is often to blame. Generally, once they've finished taking the drugs, the diarrhea clears up on its own. But the new strain is much nastier than normal. It churns out 20 times the colon-damaging toxins as the older version, causing severe intestinal inflammation, or colitis, and is resistant to several important antibiotics. When Petrosky got sick, Canadian hospitals had already reported more than 200 deaths from C. difficile--toxins had eaten right through the walls of patients' colons. Many American hospitals were experiencing similar outbreaks, and the hypervirulent strain had begun to infect people in the general community. Since then, the situation has only gotten worse.

Experts have long warned against the overuse of antibiotics because of the possibility that bacteria would develop resistance to the drugs we use to kill them. Now, researchers say, some of their fears have come to pass. The CDC estimates that of the approximately 2 million bacterial infections Americans acquire in hospitals each year, 70% are resistant to at least one of the drugs commonly used against them. Why that's scaring the experts: If standard drugs don't work, doctors sometimes have to turn to more potent--and more toxic--alternatives. In some cases, those last-resort antibiotics have caused irreversible liver or kidney problems or lasting pain from nerve damage. In others, people have died for lack of an effective treatment. The CDC says that drug resistance kills 70,000 Americans each year--more than car accidents and homicides combined.

"The superbugs are here," says Martin J. Blaser, MD, president of the Infectious Diseases Society of America and the chair of New York University Medical School's department of medicine. "And it doesn't take a crystal ball to see that even more problems are coming." 

Scientists are trying to develop new bacteria-fighting drugs, but that process takes decades. In the meantime, we have to defend ourselves. It's crucial to be able to recognize the warning signs of a superbug infection, or, even better, prevent one. Here are four of the most dangerous of these germs and how leading experts say you can protect yourself.

Superbug C. difficile: A Toxic Intestinal Bug

When Petrosky got to the hospital, doctors immediately put her on extrapowerful antibiotics. She improved, but her right arm went numb from medicine-induced nerve damage; when her physicians switched drugs, she relapsed. It took more than 9 weeks to get her out of danger. After her recovery, her 4-year-old son and a neighbor went through similar bouts of illness. The neighbor had to be hospitalized.

The number of new cases of C. difficile-associated colitis among US hospital patients has doubled over the past 5 to 10 years, to as many as 500,000 a year, reports CDC medical epidemiologist L. Clifford McDonald, MD. The infection rate outside hospitals appears to have increased many times over, as well. And the death rate has skyrocketed: from less than 2% to as high as 17%.

Prevent It

Don't badger your doctor for unnecessary antibiotics. Remember: Antibiotics don't work against viral infections such as colds or flus.

Ask about alternatives if your doctor suggests long-term antibiotics for a chronic bacterial infection such as acne. (Try remedies like benzoyl peroxide cream instead.)

Avoid broad-spectrum antibiotics, if possible, when an illness requires an antibiotic. (Broad spectrum means they kill off good bacteria along with the bad.) The broad-spectrum antibiotics most associated with C. difficile infection are clindamycin (Cleocin), and the fluoroquinolones (Cipro, Floxin, and Levaquin).

Consider upping your intake of "friendly" bacteria, such as Lactobacillus and Bifidobacterium. They can be found in many brands of live-culture yogurt. Such a step can't hurt; research continues on whether it can help deny bad bugs a foothold in your system.

 Treat It

Contact your doctor if you have diarrhea or cramping and gas that lasts longer than a few days, and avoid antidiarrheal remedies, which can prevent your body from expelling C. difficile's tissue-damaging toxins. Instead, drink lots of fluids to stay hydrated and try the BRAT diet: bananas, rice, applesauce, and toast.

Superbug MRSA: Out of the Hospital and in your Community

On Christmas night, 2005, 14-month-old Bryce Smith had a stuffy nose and slight fever--his first cold, say his parents, Katie and Scott Smith of Santee, CA. Around midnight on New Year's Eve, Bryce began to struggle frighteningly for breath. The Smiths rushed him to the hospital, where a nurse checked his oxygen level. Within seconds, Katie recalls, at least 10 doctors and nurses had crowded around her baby, looking very scared.

X-rays and CT scans showed that Bryce's lungs were riddled with holes, and a team of surgeons hurried him into the operating room. Doctors told the Smiths that Bryce had the worst kind of lung infection, one caused by a particularly virulent variety of staph bacteria. Dubbed CA-MRSA, for community-acquired methicillin-resistant Staphylococcus aureus, the bacteria is resistant to penicillin, amoxicillin, and the other "cillins." And it produces poisons--which were chewing up Bryce's lungs.

Bryce lay in a medically induced coma for a month as doctors infused his body with a cocktail of antibiotics, sedatives, and other drugs. The medicines worked: After 40 days, the doctors brought him out of sedation and removed his tubes. But his parents have to be supervigilant now, because the treatment weakened his immune system, at least temporarily. "What would be an ordinary cold for us could prove deadly for him," his dad says.

Staph causes problems only when it slips past the body's defenses, through a cut or scratch or into lungs weakened by a viral infection. Close contact--on playing fields, in locker rooms and showers, and between children in day care and preschool--has been the key to many outbreaks. (Young children appear to be particularly at risk.)

MRSA made headlines in 2005 when Miami Dolphins Junior Seau and Charles Rodgers were hospitalized with limb-threatening skin infections and college football player Ricky Lannetti of Philadelphia died suddenly of MRSA pneumonia on the heels of the flu. And a study in the New England Journal of Medicine startled physicians by revealing that the bug now causes more than half of all skin infections treated in US emergency rooms. It's crucial, say researchers, for doctors to keep the possibility of MRSA in mind--the study found that most cases of MRSA were treated with drugs that don't work against the superbug.

How To Avoid MRSA

Prevent It

* Wash cuts and scrapes thoroughly with soap and water.

* Don't share personal items such as towels and razors, and just in case you have a scratch that would offer entry to MRSA, always keep your clothing or a towel between your skin and any shared surfaces such as workout equipment or locker-room benches. *

* Get vaccinated against the flu--the disease clearly raises the risk of the most severe kind of staph infections.

Treat It

* Don't ignore an infected wound or a pus-filled boil--not even a scratch, if it seems to worsen over the course of a few days. MRSA skin infections tend to be very red, swollen, and painful, sometimes with a raised bump resembling a spider bite. Getting the right antibiotic is critical, so ask your doctor to consider the possibility of MRSA.

* Be particularly vigilant about any chest cold or flu that takes a sudden turn for the worse, or a fever that spikes over 102 degrees F. "Every major medical center is now on the alert for MRSA," says John Bradley, MD, chief of infectious disease at Rady Children's Hospital--San Diego, where Bryce was treated. "But there's still a problem with general practitioners and small community hospitals, where doctors may never have seen a case."

Superbug E. Coli: Food's Dangerous Hitchhiker

Frightening news stories recently about the damage done by tainted spinach made it horrifyingly clear: Produce, like meat, can harbor lethal germs. The culprit in spinach, E. coli 0157:H7, is not antibiotic resistant (in fact, antibiotics are not used to treat this infection), but is indisputably extratoxic; the poisons it produces can cause fatal kidney failure. Strains of other foodborne bugs, Salmonella and Campylobacter, turn out vicious toxins, as well--and these bugs shrug off many drugs that once could vanquish them. All told, these pathogens sicken 3 to 4 million Americans each year and kill several hundred.

Prevent It

Be scrupulous about washing hands after touching raw meat or eggs, and cook these foods thoroughly. (More than half of all cuts of raw supermarket chicken carry Salmonella and Campylobacter, studies show.)

Use hot, soapy water to wash cutting boards and other kitchen surfaces that come in contact with raw meat or eggs.

Rinse produce--even veggies and fruits with a thick rind, such as cantaloupe--with a strong spray of water. If produce is contaminated by irrigation water, as was the case with spinach, only thorough cooking will destroy the germs.

Wash your (and your kids') hands after handling pet rodents and reptiles or farm animals, which can spread Salmonella and Campylobacter.

Throw your kitchen sponges into the dishwasher daily and dishrags into the washing machine often; use hot water.

Treat It

 See a doctor for severe gastrointestinal distress that lasts more than a couple of days, especially if accompanied by fever. If your doctor prescribes an antibiotic, call back if symptoms worsen or don't get better within 24 hours.

Superbug UTI: Bladder Infections That Won't Quit

The first time Dena Kelley got a urinary tract infection, she ended up in the emergency room. It was the winter of 1999, and Kelley, now a 33-year-old store manager in Anchorage, was seeing what looked like tissue in the toilet bowl--the lining of her infected bladder. "It was unbelievably painful," she says, "and it scared the heck out of me."

The ER doc gave Kelley a powerful antibiotic--Cipro--to stop the infection fast, but 6 weeks later, Kelley got another UTI. Over the next year, she averaged an infection every 2 months. Finally, her doctors reluctantly turned to a drug to which she'd been allergic in childhood--amoxicillin, at four times the usual dose. Fortunately, Kelley had outgrown her sensitivity to the drug, which ended the agonizing bouts of UTIs. But she can no longer make it through the night without a trip to the bathroom. And her doctors have told her that permanent bladder damage may predispose her to chronic infections throughout her life.

Roughly half of all women get at least one UTI at some point in their lives. Until the late 1990s, doctors were able to treat the problem with trimethoprim-sulfamethoxazole (Bactrim), a narrowly targeted antibiotic with minimal side effects. But many UTIs have become resistant to Bactrim and other drugs. So doctors must use stronger antibiotics that can cause problems of their own.

"It's frustrating," says Gazala Siddiqui, MD, a urogynecologist at the University of Texas Medical School at Austin. "These powerful antibiotics increase the chances of a yeast infection, and also the chances that a woman's next bacterial infection--whether it's another UTI or pneumonia--will be drug resistant."

If a resistant UTI lingers, it can cause scarring--which predisposes a woman to even more UTIs. Some doctors try to stop the vicious cycle by keeping women on antibiotics for months at a time. But that virtually guarantees that any break-through infections will be impervious to antibiotics, says Siddiqui, who's sometimes had to admit patients to the hospital for intravenous treatment.

Prevent Antibiotic-Resistant Bladder Infections

Prevent It

Begin with good vaginal hygiene: Wipe from front to back after using the toilet and pee before and after sexual intercourse. Don't douche, and consider alternatives to spermicides; both can irritate the delicate tissue around the urethra, raising the odds of infection.

Discourage UTI-causing bacteria by making the urinary tract and vagina more acidic. "Cranberry juice is good at this. Cranberry capsules are better," says Siddiqui, who recommends two or three glasses or capsules a day for women who are prone to recurrent infection. Also helpful: acidifying vaginal jelly available by prescription (Acigel) or over the counter (RepHresh).

Try a low-estrogen vaginal cream if you're peri- or postmenopausal and getting lots of UTIs. It will keep the tissue of the urethra from thinning and becoming more vulnerable to infection.

Treat It

If you suspect a UTI, ask your doc to send a urine sample for analysis. Start antibiotics, but call back for results. If it turns out not to be a bacterial infection, stop the drugs and work with your doc to find the true cause. If a bacteria is at fault, check to make sure the drug you're on is effective against the bug you have.

3 Stay-Healthy Moves To Make Right Now

1. Scrubbing with old-fashioned soap and hot water is the best way to keep germs at bay. Do it before eating, after using the toilet or handling animals, and before and after preparing food. Wash vigorously for 20 seconds, experts say--about the time it takes to sing "Yankee Doodle Dandy."

 
2. If a sink isn't handy, clean up with an alcohol hand sanitizer. Studies show that when someone is sick in a household, classroom, or workplace, using a gel (between hand washings) reduces the spread of disease-causing bacteria and viruses. Be sure to choose a product containing 60 to 95% alcohol--some contain less and can actually help spread germs. Use a generous gob--enough so that hands still feel damp after rubbing them together for 20 seconds.

 3. Skip antibacterial soap. Household soaps and other products with antibacterial chemicals, such as triclosan and triclocarban, don't prevent infection any better than products without them, studies show. Worse, some experts worry that they may promote drug resistance. There's no proof yet that they do, admits resistance crusader Stuart B. Levy, MD, of Tufts University. "But why take the risk when they haven't been shown to be any more effective?"

Have A Healthy Hospital Stay

Ironically, "A hospital is not a good place to be when you're sick," says Curtis Donskey, MD, chief of infection control at the Cleveland VA Medical Center. Filled with the sickest patients on the strongest antibiotics, they're breeding grounds for superbugs. Unfortunately, many doctors neglect the steps that can reduce patients' risk of picking up nasty germs during their stay, says Donskey, who has spent a decade raising awareness among his colleagues. Enlist a friend or family member to help ensure that doctors and other medical personnel follow these guidelines.

* Ask your doctor to remove invasive devices such as catheters and IV lines as soon as it's safe--they provide a pathway into your body for dangerous bacteria.

* Request the most highly targeted antibiotic if you require one. Remind your doctor to take you off the drug as soon as possible.

* Demand to know more about infection rates. Few states now require hospitals to release this information, so it's next to impossible to "shop around" to avoid particularly risky facilities. That may be changing: New York recently passed a law requiring hospitals to make public their rates of hospital-acquired infection, and a number of other states are considering similar legislation.

Writer Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health & Survival in a Bacterial World (Hill&Wang/FSG) and Corpse: Nature, Forensics, and the Struggle to Pinpoint Time of Death (Perseus/Basic Books).

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If you're over 30, those childhood shots have probably worn off. Here's what you need to know ...

copyright Jessica Snyder Sachs, as first appeared in HEALTH magazine

Three months before she gave birth last year, Diana Simpson, a dental hygienist in Davison, Michigan, started coughing uncontrollably. The pain in her throat and chest was unbearable. "It brought me to tears," she remembers. Simpson's family doctor tested her for asthma, but she didn't have asthma. She had pertussis, a bacterial infection that usually goes by the name whooping cough because of its distinctive seal-like cough.

Most people are vaccinated against pertussis as kids. But here's a surprise: It's come roaring back since an all-time low in the 1970s, largely due to waning immunity in adults who received shots in early childhood. The Centers for Disease Control and Prevention (CDC) now recommends that all adults get a pertussis booster shot to strengthen their immunity, yet only 2 percent of adults have had their shots updated. Experts say that's just one of several vaccines you may need now. Here's the scoop.

Whooping cough
Vaccine: Tdap

The good news: If you get your regular tetanus-diptheria (Td) booster every 10 years, you won't need an extra jab for pertussis. Vaccine makers have added a pertussis component to that booster, so next time you're due for your Td booster request the Tdap. If you've lost track of your vaccines, ask your doc to contact your previous physicians. And there's no harm in getting the Tdap as long as two years have passed since your last Td booster. Better too soon than too late when a pertussis outbreak has hit your community.

Simpson was too late: She had passed the infection to her mother and her baby, too, landing the newborn in the hospital three weeks after he was born. That's when they all were diagnosed and received the antibiotic erythromycin to keep the infection from spreading further, though they all continued coughing for months. If pertussis isn't caught in the first few weeks, the infection may take three months to run its course. The greatest danger is to babies, who almost always catch it from unvaccinated adults. (The number of U.S. pertussis cases now ranks in the thousands each year, with deaths in the double digits, mostly due to related pneumonia.)

Simpson and her baby, along with her mother (and husband, too), eventually got the shot for future protection.

Chicken pox
Vaccine: Varivax

More than 90 percent of women in their childbearing years are immune to chicken pox because they had it as kids. The rest should be vaccinated before they try to get pregnant because catching the illness during pregnancy can lead to devastating birth defects. Once you get the vaccine (which was introduced in 1995), the CDC says you should delay trying to conceive for at least one month, due to the small risk that the fetus can get the virus from the vaccine. Chicken pox complications are much more frequent and severe in adults than children and can include life-threatening pneumonia and encephalitis (brain inflammation). And people who've had it are also at risk for shingles. Most insurers cover the chicken pox vaccine for adults.

Shingles
Vaccine: Zostavax

If you've had chicken pox, you have a significant risk of developing shingles, a painful reawakening of the chicken pox virus. Worse, in nearly 50 percent of cases in adults in their 50s, shingles progresses to postherpetic neuralgia, an often agonizing form of nerve damage that can linger for years. (The risk increases with age.) But with the recent Food and Drug Administration (FDA) approval of the Zostavax vaccine, you can lower your risks dramatically. In a study of more than 38,000 adults over age 60, the vaccine cut the rate of shingles by over half and reduced the incidence of postherpetic neuralgia by two-thirds.

The vaccine was studied in and approved for people over the age of 60 because they have the highest rates of shingles, says William Schaffner, MD, head of preventive medicine at Vanderbilt University Medical Center. "The rates take off at age 50 and become more steep with each decade," he says. But around half of all shingles cases occur in younger adults.

Insurers won't currently pay for vaccination in people under 60, but that may change because studies in 50-and-overs are ongoing. Younger adults can pay out of pocket for this $150 to $200 shot. (Ask your doctor.) Researchers don't yet know whether the vaccine's protection will prove lifelong, though, so you may need a booster when you get older.

The mumps
Vaccine: MMR booster

The measles-mumps-rubella (MMR) vaccine, a must for kids, is back in the adult-vaccine lineup, too. "Mumps is the problem," reports CDC epidemiologist Andrew Kroger, MD. The number of Americans who caught this viral disease jumped to 6,584 in 2006 from 300 or less in most years. A large mumps outbreak in the Midwest was responsible for most of these cases, and outbreaks continue in Canada and neighboring states such as Maine. The problem may be a spillover from countries like the United Kingdom and Japan, where lagging childhood immunization rates spurred a comeback.

Mumps can be painful and sometimes dangerous. There's the textbook swelling of salivary glands around the neck, but some women also suffer from inflammation of the ovaries. In rare instances, mumps can trigger life-threatening encephalitis.

The CDC encourages all adults to check their status: Do you know whether you were immunized or had the disease as a child? Those born before 1957 are presumed to have been infected or exposed, which provides lifelong immunity. The spottiest protection is among those born between 1957 and 1967, who are less likely to have had mumps or who may have received a less-effective vaccine. A single dose of the current MMR should bring your protection up to date, Kroger says, and it may be covered by your insurance.

Travel Vaccines
Going on a cruise or an organized tour? Consider getting a flu shot, says Schaffner, who reports that influenza outbreaks frequently occur on cruise ships, even during summer voyages to northern destinations like Alaska. "Whenever people are jammed together, influenza is a risk," he explains. 

In addition, visitors to Asia should talk to their doctors about vaccine protection against typhoid and Japanese encephalitis. Visitors to the "meningitis belt" of central Africa should get a meningococcal vaccine. And yellow fever vaccines are important for travelers to much of South America and parts of Africa.

Hepatitis B
Vaccine: Recombivax HB or Engerix-B

Both vaccines protect against the hepatitis B virus, which is spread through sexual contact or contaminated needles and blood. An infection can lead to dangerous liver disease. Each year, more than 78,000 Americans become infected and about 5,000 die of associated liver diseases, including cancer, yet few know that the CDC recommends the vaccine for all sexually active people who are not in long-term relationships.

Flu

Vaccine: Influenza shot or FluMist nasal vaccine

A dangerous bug known as methicillin-resistant Staph. aureus (MRSA) may aggressively attack flu-weakened lungs, according to William Schaffner, MD, head of preventive medicine at Vanderbilt University Medical Center. MRSA was previously confined to hospitals but is spreading into communities nationwide. The link is unclear, but there may be a connection in the way that flu weakens the immune system and MRSA attacks it. MRSA is often marked by nasty skin infections. The strains contracted outside the hospital are now associated with some 13,500 deaths in the United States each year, many involving flu sufferers. "If you need further motivation to get a flu shot," Schaffner says, "there it is."

Jessica Snyder Sachs is the author of Good Germs, Bad Germs, out in paperback this fall.

A guide to address your top worries

copyright Jessica Snyder Sachs & Parenting magazine

When Katie Shutters's 13-month-old daughter, Averie, was born, she followed the recommended vaccine schedule for two months. Then she did some research and decided to hold off on additional shots until Averie turned 9 months old. "I liked the idea of my breast milk giving her the immunities she needs and allowing her body to work for her instead of some medicine," says the stay-at-home mom from Indianapolis. "She isn't in daycare, and we don't travel overseas. I had concerns about injecting her for no reason."

Eventually Shutters found a doctor who would immunize according to her schedule: "We broke up the MMR [which protects against measles, mumps, and rubella] into three separate shots spread out over a year, and we're skipping the chicken pox shot," she says. "Instead, I'd love to find a kid who has chicken pox so we could expose Averie naturally."

If Shutters's approach to vaccination sounds familiar, that's because it is. In fact, most moms don't have to look far beyond their circle of friends to find a family with serious concerns. It's not difficult to understand why. For one, it can be torture to watch your child get jabbed repeatedly with a needle. Combine that discomfort with a steady stream of negative publicity -- celebrity diatribes, alarmist news and Internet reports, ripped-from-the-headline TV shows -- and the wariness seems warranted.

Yet underneath all the debate and good intentions (after all, everyone hopes to be doing the best for their child no matter how or whether they immunize), there are some solid facts about the benefits of shots that cannot be ignored. "We live thirty years longer now than we did a century ago, thanks to purified water -- and vaccines," says Paul Offit, M.D., chief of infectious diseases at the Children's Hospital of Philadelphia. But as soon as compliance wanes, the protection we have against many devastating, and sometimes fatal, diseases wanes right along with it. This year's measles outbreak -- the biggest in nearly a decade -- may be the first warning shot, says Dr. Offit. Nearly all of the 131 people affected so far, many of them children, were purposely not vaccinated against the disease, according to a new report from the Centers for Disease Control and Prevention (CDC), in Atlanta. "We have to take this seriously," says Anne Schuchat, M.D., director of the CDC National Center for Immunization and Respiratory Diseases. "I do not want to see the day where thousands of kids get this disease and die when we have the tools to prevent it."

So what's a worried mom to do? [READ MORE IN THE NOVEMBER ISSUE OF PARENTING MAGAZINE]


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